Pre-hypertension, pre-diabetes or both: which is best at predicting cardiovascular events in the long term?

The present study aimed to assess the value of pre-diabetes and pre-hypertension in predicting cardiovascular events. A population-based, cross-sectional survey was conducted, representing a large sample of the general Iranian population aged 35 years and older from the Isfahan Province and determined using a random, multistage cluster-sampling 10-year cohort. The five end points considered as study outcome were unstable angina (UA), acute occurrence of myocardial infarction (MI), sudden cardiac death (SCD), brain stroke and cardiovascular disease (CVD). Of the 6323 subjects scheduled for assessment of diabetes state 617 were diabetics and 712 were pre-diabetic. In addition, of these subjects, 1754 had hypertension and 2500 had pre-hypertension. Analysing only pre-hypertension, pre-diabetes and its combination and adjusted for gender and age variables, pre-hypertension and pre-diabetes status together, could only effectively predict occurrence of MI (hazard ratio (HR) = 3.21, 95% confidence interval (CI): 1.06–9.76, P = 0.04). In the same COX regression models, pre-hypertension status could predict UA and CVD occurrence (HR = 2.94, 95% CI: 1.68–5.14, Po0.001 and HR = 1.74, 95% CI: 1.23–2.47, P = 0.002, respectively). However, pre-diabetes status could not predict any of these events after adjustment for gender and age. Our data provide valuable evidence of the triggering role of pre-hypertension and pre-diabetes together, on appearance and progression of MI even in healthy individuals and the significant predicting value of pre-hypertension on the occurrence of UA and CVD. In this regard, the value of pre-hypertension and prediabetes together, and the pre-hypertension state alone, are clearly superior to pre-diabetes state alone in predicting cardiovascular event

Evaluating the impact of fractional flow reserve-guided percutaneous coronary intervention in intermediate coronary artery lesions on the mode of treatment and their outcomes: An Iranian experience.

BACKGROUND: Today, the fractional flow reserve (FFR) guides the physician to select suitable patients with intermediate severity coronary lesions in angiography that should be treated or not with stent. The aim of this study was to evaluate the impact of using FFR in the selection of appropriate treatment strategy in angiographic intermediate coronary lesions and their short-term outcome in a sample of Iranian population. METHODS: In a prospective cohort, 34 patients who had intermediate coronary artery lesion(s), defined as having a 40-70% diameter stenosis, as determined by visual estimation or quantitative coronary angiography were enrolled through a convenience sampling method. All patients underwent FFR measurement to decide whether percutaneous coronary intervention should be performed. The results of visual assessment, quantitative coronary angiography, and functional assessment of the severity of coronary stenosis were compared. Significant stenosis was defined as FFR < 0.80. All patients were followed for 6 months for the incidence of major advanced cardiac events. RESULTS: In this study, 34 patients (22 male and 12 female) with mean age of 57 ± 8 (range 45-70) were included. In 26.47% (9/34) of patients, FFR was 0.80 and stenting was done to the other vessels with significant coronary lesions. CONCLUSION: Measurement of FFR is a useful approach in making clinical decisions about revascularization procedures in patients with moderate coronary artery lesion severity, especially in LM and multivessel disease. This study showed that not only FFR can change treatment plan of the patients, but also it would improve clinical outcomes. KEYWORDS: Coronary Angiography; Coronary Stenosis; Fractional Flow Reserve Myocardia

Evaluating factors associated with uncontrolled hypertension: Isfahan cohort study, Iran

BACKGROUND: Hypertension (HTN) considers as one of the most common risk factors, which potentially raises the risk of cardiovascular disease. Regarding high prevalence of HTN among Iranian population this study designed to examine a range of socio-demographic and clinical variables to determine the association with failure to achieve blood pressure control in a cohort of hypertensive subjects. METHODS: This retrospective cohort study is a part of Isfahan cohort study which carried out on adults aged 35 years old or more. Subjects with confirmed HTN entered in this sub-study. For all subjects questionnaire included socio-demographic characteristics, clinical data and lifestyle behavior completed by trained nurses. Uncontrolled HTN was defined as systolic and diastolic blood pressure more than 140/90 in the presence or absent of pharmacological treatment. RESULTS: The prevalence of uncontrolled men was significantly higher than controlled in both 2001 and 2007 (P < 0.001). A significant association was found between sex and control of blood pressure: compared with women, being men [odds ratio (OR) = 2.31; 95 % confidence interval (CI) = 1.64-3.24] was significantly associated with uncontrolled HTN in 2001 and (OR = 2.38; 95% CI = 1.78-3.18). Among lifestyle behaviors, tendency for more consumption of salty foods increased the risk of uncontrolled HTN in 2001 by 1.73 times [OR = 1.73, 95% CI = 1.20-2.50, (P = 0.003)]. Patients who were naive to mono-therapy without considering the type of antihypertensive drug were found to be associated with uncontrolled blood pressure (OR = 0.14; 95 % CI =0.1-0.2). CONCLUSION: Uncontrolled HTN was sex, marital status, diabetes, tendency to salty foods and medication adherence. Assessment of them presence of these risk factors is warranted to recommend an aggressive HTN management with the goal of reducing excessive risk of cardiovascular events caused by uncontrolled HTN

Prognostic factors of 28 days survival rate in patients with a first acute myocardial infarction based on gender in Isfahan, Iran (2000-2009)

BACKGROUND: Determinant prognostic factors of 28 days survival rate in patients with a first acute myocardial infarction (AMI) based on gender in teen year�s period in Isfahan, Iran, was the aim of this study. METHODS: This study is a prospective hospital-based study that consisted, all patients with AMI admitted to all hospitals (private and universal hospitals) in Isfahan and Najafabad (Iran) during 2000-2009. To determinant the prognostic factors of 28 days survival rate in patients based on gender, analysis conducted separately for male and female. In analysis, we use of t-test, log Rank tests, Kaplan�Meier method, and univariate and multivariate Cox regression model. RESULTS: Short-term (28 days) survival rate was 92.5 in male and 86.7 in female (P < 0.001). The adjusted hazard ratio (HR) of death for age group 80 years and older was 12.7 95% confidence interval (CI): 5.14-31.3 in male and 8.78 (95% CI: 1.2-63.1) in female. HR for acute transmural MI of the unspecified site in male was 8.9 (95% CI: 4.68-16.97) and in female 9.33 (95% CI: 4.42-19.7). HR for receive of streptokinase in male was 1.11 (95% CI: 0.94-1.31) and in female was 0.69 (95% CI: 0.56-0.84). CONCLUSION: Short-term survival rate in male was a higher than female. In male age, anatomic location of MI and hospital status and in female streptokinase use and anatomic location of MI was the most important prognostic factors of survival in-patient with AMI in Isfahan. © 2015, Isfahan University of Medical Sciences(IUMS). All rights reserved

Comparison of the effect of different intensity exercise on a bicycle ergometer on postprandial lipidemia in type II diabetic patients

BACKGROUND: Postprandial lipid clearance failure and lipoprotein disorders, which are independent risk factors for cardiovascular diseases are well-recognized in type II diabetes. Reduction of fats through exercise has been proved, though the mechanism is not well-defined, and the effects of different intensity exercise on postprandial lipidemia in diabetes type II is unknown. This study aims to find these effects using a cycle ergometer. METHODS: On three different days, 15 type II diabetics (10 women and 5 men, with a mean age 42.07 &plusmn; 6.05 years, weight 94.64 &plusmn; 4.37 kg, height 159.78 &plusmn; 9.09 cm, and body mass index 29.83 &plusmn; 3.93 kg/m2), consumed a full fat breakfast (750-800 kcal, 85% fat), and 150 min later, blood samples were taken from them to measure their lipid profile. The 1st day was the control day, without any exercises. Seven days later, 90 min after enriched breakfast, they did 30 min of exercise on the cycle ergometer with intensity of 55-70% of maximum heart rate (HRmax), and 14 days later, 90 min after enriched breakfast, they did 30 min of exercise with intensity of 70-85% of HRmax. RESULTS: According to Friedman non-parametric test, high-density lipoprotein (HDL) cholesterol serum level significantly increased after 30 min of moderate intensity exercise (P &gt; 0.05, from 39.4 &plusmn; 5.2 to 48.6 &plusmn; 9.3), while this increase was insignificant after a higher intensity exercise. Neither intensity levels had any significant effects on triglyceride or on low-density lipoprotein cholesterol. CONCLUSION: Results showed that moderate intensity exercise was more effective in increasing HDL cholesterol level in type II diabetics. &nbsp; Keywords: Postprandial Lipidemia, Resistance Exercise, Bicycle Ergometer, Type II Diabetes&nbsp;</div

Contrast-induced nephropathy; A literature review

Context: Contrast–induced nephropathy (CIN) is a common cause of acute kidney dysfunction. Evidence Acquisitions: Directory of Open Access Journals, Google Scholar, PubMed, EBSCO and Web of Science have been searched. Results: It is necessary to identify at risk patients at early stages to implement preventive strategies to decrease the incidence of this nephropathy. However, mechanisms of CIN have not fully explained yet. It seems that mechanisms which mediated by nitric oxide and prostaglandin-induced vasodilatation have been played a crucial role in the CIN. Hemodynamic changes of renal blood flow, which causes hypoxia in the renal medulla and direct toxic effects of contrast media on renal cells, are thought to contribute to the pathogenesis of CIN. Contrast media is normally divided into iso-osmolar, low-osmolar, and high-osmolar. N-acetylcysteine is considered as one of the best choices to prevent CIN in high-risk groups. Conclusions: The first aim to prevent CIN is identifying high-risk subjects and controlling associate risk factors. As significant differences existed between contrasts agents due to their physicochemical properties, low-osmolar or iso-osmolar contrast media should be used to prevent CIN in at-risk patients. The volume of contrast media should be as low as possible

The association between fasting serum insulin, apo-lipoproteins level, and severity of coronary artery involvement in non-diabetic patients

Background: In the previous studies, fasting insulin and apo-lipoproteins are considered as one of the risk-factor of coronary artery disease (CAD) but did not have the same results. In this study, we attempted to define the association of high fasting insulin and apo-lipoproteins of serum in non-diabetic patients who were afflicted with coronary arteries disease with severity of coronary arteries involvement. Materials and Methods: This study was conducted between September 2011 and February 2012 on three groups, each one consisting of 100 members while using angiographic scores of Gensini with three equal groups with low, medium, and high stenosis of coronary arteries. The evaluation of non-diabetic patients afflicted with CADs, included the fasting glucose level less than 126 mg/dl or non-consumption of blood glucose reduction drugs or negativity history of diabetes. Results: In this study, there were 300 non-diabetic patients afflicted with CAD in three groups of low, medium, and high extremity. Due to attained results, the patients afflicted with high CAD had a higher level of insulin (18.3 ± 0.8) in relation with low and medium groups (P < 0.001). As it was observed, the level of serum apo-lipoproteins of A1 (APO-A1) in low group of CAD (175 ± 36.4) is meaningfully higher than its quantity in high-CAD group (158 ± 42.4, P < 0.001). Furthermore, the quantity of serum apo-lipoproteins of B (APO-B) in mild CAD group (139 ± 30.4) is meaningfully less than severe CAD group (155.21 ± 29.7, P < 0.001). Conclusion: Our findings show that insulin, APO-A1, APO-B, and total cholesterol measurement is a good case for defining the severity of coronary artery involvement, while high-density lipoprotein, low-density lipoprotein, and triglyceride are not important risk-factors

Effect of a care plan on the quality of life of the patients with atrial fibrillation

Background: Atrial fibrillation is one of the most common cardiac arrhythmia affecting patients “quality of life (QoL).” With regard to limited number of interventional studies on such patients' QoL, the present study aimed to define the effect of a care plan on the QoL of the patients, hospitalized in coronary care unit (CCU), with atrial fibrillation. Materials and Methods: This is a randomized two-group clinical trial that was conducted on 50 patients, diagnosed with atrial fibrillation and hospitalized in CCU. Fifty patients were selected through convenient sampling and were randomly assigned to study (n = 25) and control (n = 25) groups. Study group underwent an already designed care plan, while the control group received just routine care. QoL was measured by Short Form (SF-36) QoL questionnaire before and one month after intervention. Data were analyzed by t-test through Statistical Package for the Social Sciences. Results: Independent t-test showed a significant difference in mean scores of overall QoL and all of its domains (p < 0.05), except for general health (t = 1.23, p = 0.22) and social function (t = 1.70, p = 0.09). The t-test showed a significant difference in mean (SD) scores of overall QoL in study [51.57 (14.57)] and control [41.80 (18.51)] groups after intervention (t = 2.07, p = 0.04). Conclusions: The results showed that an already designed care plan can result in improvement of QoL in patients with atrial fibrillation. In the present study, a standard care plan was administrated for the patients with atrial fibrillation. Through administration of care plans in clinical settings, nurses' clinical and effective role can be improved

The role of Inflammatory Processes in Occurrence of Left Ventricular Failure in Patients with Chronic Kidney Disease

Background: Recently, the relationship between increased level of inflammatory mediators and occurrence of left ventricular failure in patients with kidney disease has been suggested. The present study attempted to assess relationship between inflammatory mediators and occurrence of left ventricular failure in patients with chronic kidney disease. Materials and Methods: This cross-sectional study was performed at Noor and Hazrat Aliasghar hospital in Isfahan between September 2012 to September 2013 on patients aged >19 years that referred for following their chronic kidney disease. Serum level of inflammatory parameters including C-reactive protein (CRP) and Interleukin-6 (IL-6) was measured using spectrophotometer. All patients were also assessed using M-mode echocardiography to determine left ventricular ejection fraction (LVEF). Results: The group with significant reduced LVEF showed lower GFR when compared to the normal LVEF group (40.73 ± 20.61% versus 44.43 ± 17.98%, P = 0.032). Comparing GFR across the three groups with normal LVEF >55%), with mild LV dysfunction (LVEF: 45 – 55) those with significant LV dysfunction (LVEF < 45%) showed significantly lower GFR level in latter group compared with normal LVEF and mild LV dysfunction group (P = 0.026). Although the level of serum CRP was significantly higher in patients with significant left ventricular failure than other groups (P = 0.018). Conclusion: Inflammatory processes can potentially affect left ventricular function in patients with chronic kidney disease. In this regard, increased level of CRP may be a main factor for predicting severity of left ventricular failure in these patients

Potato consumption as high glycemic index food, blood pressure, and body mass index among Iranian adolescent girls

BACKGROUND: Potato as a high glycemic index food has different effects on healthy nutritional status. In the current study, we investigated the association between potato consumption and obesity and blood pressure among adolescent girls. METHODS: This cross-sectional survey was conducted on 205 girls (11-13 years old) in 2013 who were selected by systematic cluster random sampling from schools of all regions of Isfahan, Iran. Dietary intakes were collected by 53-items food frequency questionnaire. Anthropometric measurements were done based on a standard protocol. RESULTS: Adolescents that consumed all kinds of potato more than once per week had significantly higher prevalence of overweight and obesity (prevalence of overweight and obesity was 86.7 and 13.3%; P &lt; 0.0010 in more than once per week and less than once per week groups, respectively) as well as prevalence of abdominal obesity in more than once per week consumption group was higher than less than once per week consumption group (78.2 vs. 21.8%; P &lt; 0.001). Potato consumption (as independent variables) increased body mass index and waist circumference (as dependent variables) in crude and adjusted regression models (P &lt; 0.050). Mean blood pressure was not significantly different among lower and higher potato consumers. CONCLUSION: Our findings suggested a positive association between potato consumption and obesity. We did not find any association between potato consumption and blood pressure in adolescents.&nbsp;</div